冠脉CTA：冠脉解剖.ppt

CoronaryCTA:coronaryanatomyterminology-Acardiologist’sperspectiveJuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity1.

冠脉CTA：冠脉解剖JuileMillerMDAssistantprofessorofMedicineInterventionalCardiologyJohnsHopkinsUniversity2.

ArteryDescriptionOrigin:Originatingcusp/sinusofvalsalvaCourseBranchnameSize(caliberanddistribution):smallmediumlargeDominanceAdequacyofimagequalityforinterpretationoverall，pervessel，persegment3.

动脉的描述起点：起始点/valsalva窦行程分支名称大小（口径及分布）：小、中、大支配区域合适的图像质量：总体，每条血管，每个层面4.

NormalLeftMain(LM)Origin-leftsinusvalsalva-Absentin1%Separate,adjacentLADLCXostia-0.5%Branches:LADLCX=85%LAD,LCXandRamus10-15%Criticalissues:－stenosisduetoriskregion－Presenceofostialdisease－Other:aneurysmsanomaloustakeoff5.

左冠状动脉主干（LM)起点：左valsalva窦（左冠窦）1％例外直接分出LADLCX占0.5％分支：分出LADLCX占58%LAD,LCX和中间支10-15%关键问题：狭窄致局部供血不足冠状动脉口疾病动脉瘤，（内膜）不规则剥离6.

LeftAnteriorDescending(LAD)Origin:-FormLeftMain95-99%-1-3%separateostiumLeftsinusCourseAnteriorintraventriculagroovetowardapex2variationsinterminationBranches:DiagonalsseptalperforatorsCriticalissuesPresenceofostial/proximaldiseaseMyocardialbridgesOther:aneurysmsanomaloustakeoff7.

左前降支（LAD）起点：95－99％起源于LM1-3%直接开口于左冠窦行程：心室前方经室间沟达心尖最后分为两支分支：角支室间隔支关键问题：冠状动脉近端或冠状动脉口疾病心肌桥动脉瘤，（内膜）不规则剥离8.

NormalAnrtomy（LAD)9.

LeftCircumflex(LCX)Origin:OriginatingformLMin96-98%5-2%separateostiumLCXoriginformrightsinusorRCA(0.4%)Course:downdistalleftAVgrooveBranchesobtusemarginalbranchesLeftposterior-lateral:definebyacutemarginandsupplyPLwallLeftposteriordescending(ifdominant)Criticalissuesdominance(15-20%)10.

起点：96-98%起源于LM5-2%单独开口LCX起源于右冠窦或RCA约0.4%行程：沿着左房